Symptoms of Kidney Stones
Kidney stones typically present with severe flank pain (renal colic) that radiates to the groin, hematuria, dysuria, urinary frequency, nausea, vomiting, and sometimes fever if infection is present. 1
Primary Symptoms
- Renal colic: Sudden onset of severe, sharp pain in the flank (side) or lower back that may radiate to the lower abdomen and groin
- Hematuria: Blood in the urine, which may be visible (gross) or microscopic
- Urinary symptoms: Dysuria (painful urination), urinary frequency, and urgency
- Nausea and vomiting: Often accompanies severe pain episodes
- Groin pain: Pain may radiate to the testicles in men or labia in women
Severity Indicators
The American College of Radiology notes that moderate to severe hydronephrosis is highly specific (94.4%) for symptomatic renal stones 1. Patients should seek immediate medical attention if they experience:
- Severe pain unrelieved by over-the-counter medications
- Pain accompanied by fever and chills (suggests infection)
- Nausea and vomiting preventing medication or fluid intake
- Inability to urinate
- Gross hematuria (visible blood in urine)
Pain Characteristics
Pain from kidney stones is typically:
- Intermittent and colicky in nature
- Described as one of the most severe pains experienced
- Often causes the patient to move constantly trying to find relief
- May change in location as the stone moves through the urinary tract
Stone Location and Symptom Correlation
Symptoms vary depending on stone location:
- Kidney stones: Dull, aching flank pain
- Stones in ureter: Sharp, severe pain that radiates from flank to groin
- Stones at ureterovesical junction: Urinary frequency, urgency, and dysuria
Associated Findings
- Urinalysis findings: Microscopic hematuria, crystals, indicators of infection 1
- Hydronephrosis: Detected on imaging, indicates obstruction
- Ileus: Abdominal distention and decreased bowel sounds may occur with severe pain
Clinical Course
Spontaneous stone passage varies by size and location:
- 49-52% for upper ureteral stones
- 58-70% for mid-ureteral stones
- 68-83% for distal ureteral stones 2
Stones <5 mm pass spontaneously in 75% of cases, compared to 62% for stones ≥5 mm, typically within 17 days (range 6-29) 2. The passage rate is 89% for distal stones <5 mm and 75% for upper ureteral stones <5 mm 2.
Risk Factors Affecting Symptom Presentation
Several factors may influence symptom presentation:
- Obesity, metabolic syndrome, diabetes, hypertension: Associated with more complex stone disease 1, 3
- Anatomical abnormalities: May cause atypical presentations
- Stone size and composition: Larger stones and certain compositions (e.g., staghorn calculi) may present differently
- Previous stone episodes: May affect pain perception
Diagnostic Considerations
- Renal ultrasonography: Recommended first-line imaging modality 1, 3
- CT without contrast: Reference standard for urolithiasis diagnosis with sensitivity as high as 97% 2, 1
- Urinalysis: Essential for assessing urine pH, indicators of infection, and identifying crystals 1
Common Pitfalls in Diagnosis
- Confusing kidney stone pain with other conditions like appendicitis, diverticulitis, or ovarian pathology
- Missing signs of infection, which can lead to sepsis if an obstructing stone is present
- Overlooking the need for immediate intervention in cases of complete obstruction or infection
- Failing to recognize that not all kidney stones cause symptoms - some may be discovered incidentally
Remember that kidney stone symptoms can mimic other serious conditions, so proper diagnostic evaluation is essential for accurate diagnosis and appropriate management.